=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649916321
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIE C. LUGO CRUZ
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2022
-----------------------------------------------------
Last Update Date | 05/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1-99 CALLE JOSE C. VAZQUEZ
-----------------------------------------------------
City | AIBONTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00705-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-590-4963
-----------------------------------------------------
Fax | 787-735-2536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 197
-----------------------------------------------------
City | LA PLATA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00786-0197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-590-4963
-----------------------------------------------------
Fax | 787-735-2536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | MARIE C. LUGO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-590-4963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------